The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial

Arch Intern Med. 2011 Mar 14;171(5):460-6. doi: 10.1001/archinternmed.2010.540.


Background: The effect of interdisciplinary primary care teams on the use of health services by patients with multiple chronic conditions is uncertain. This study aimed to measure the effect of guided care teams on multimorbid older patients' use of health services.

Methods: Eligible patients from 3 health care systems in the Baltimore, Maryland-Washington, DC, area were cluster-randomized to receive guided care or usual care for 20 months between November 1, 2006, and June 30, 2008. Eight services of a guided care nurse working in partnership with patients' primary care physicians were provided: comprehensive assessment, evidence-based care planning, monthly monitoring of symptoms and adherence, transitional care, coordination of health care professionals, support for self-management, support for family caregivers, and enhanced access to community services. Outcome measures were frequency of use of emergency departments, hospitals, skilled nursing facilities, home health agencies, primary care physician services, and specialty physician services.

Results: The study included 850 older patients at high risk for using health care heavily in the future. The only statistically significant overall effect of guided care in the whole sample was a reduction in episodes of home health care (odds ratio, 0.70; 95% confidence interval, 0.53-0.93). In a preplanned analysis, guided care also reduced skilled nursing facility admissions (odds ratio, 0.53; 95% confidence interval, 0.31-0.89) and days (0.48; 0.28-0.84) among Kaiser-Permanente patients.

Conclusions: Guided care reduces the use of home health care but has little effect on the use of other health services in the short run. Its positive effect on Kaiser-Permanente patients' use of skilled nursing facilities and other health services is intriguing. Trial Registration Identifier: NCT00121940.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Baltimore
  • Chronic Disease
  • Cluster Analysis
  • Delivery of Health Care
  • District of Columbia
  • Female
  • Health Services / economics
  • Health Services / legislation & jurisprudence
  • Health Services / statistics & numerical data*
  • Humans
  • Male
  • Patient Care / economics
  • Patient Care / statistics & numerical data*
  • Patient Care Team* / economics
  • Patient Care Team* / legislation & jurisprudence
  • Patient Care Team* / organization & administration
  • Patient Care Team* / statistics & numerical data
  • Patient Satisfaction
  • Primary Health Care / economics
  • Primary Health Care / legislation & jurisprudence
  • Primary Health Care / organization & administration
  • Primary Health Care / statistics & numerical data
  • Skilled Nursing Facilities / economics
  • Skilled Nursing Facilities / legislation & jurisprudence
  • Skilled Nursing Facilities / statistics & numerical data
  • Treatment Outcome

Associated data